两种方式固定SandersⅡ型跟骨骨折后的力学稳定性  

Mechanical stability of SandersⅡtype calcaneal fractures fixed by two internal fixation methods

作　　者：温明韬 梁学振 李嘉程 许波[1,2] 李刚[1,2] Wen Mingtao;Liang Xuezhen;Li Jiacheng;Xu Bo;Li Gang(Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong Province,China;Department of Microscopic Orthopedics,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,Shandong Province,China)

机构地区：[1]山东中医药大学,山东省济南市250355 [2]山东中医药大学附属医院显微骨科,山东省济南市250014

出　　处：《中国组织工程研究》2022年第6期838-842,共5页Chinese Journal of Tissue Engineering Research

基　　金：济南市科技计划项目(201907008),项目负责人:李刚。

摘　　要：背景:对于SandersⅡ型跟骨骨折,锁定钢板内固定的"L型"切口易发生皮瓣坏死等并发症,而撬拨复位后空心螺钉内固定可以很好地避免此问题,但仍然缺乏内固定效果的评价。目的:基于有限元分析方法,比较研究SandersⅡ型跟骨骨折2种固定方式的固定效果与力学稳定性。方法:筛选1名男性志愿者(25岁,身高175 cm,体质量75 kg),应用断层CT对胫骨中段至全足行全层连续扫描。通过CT扫描数据,建立完整跟骨的三维有限元分析模型。模拟SandersⅡ型跟骨骨折,分别行锁定钢板固定(锁定钢板组)及撬拨复位后空心螺钉加压固定(空心螺钉组)。对两组模型施加相同约束与载荷下比较2种固定方式的应力分布、位移情况及骨折块位移表现。结果与结论:(1)空心螺钉内固定的应力集中于骨折线接触附近,最大Von Mises应力达53.948 MPa,横向空心螺钉相较纵向螺钉位移较大,最大位移达0.17537 mm;锁定钢板内固定应力与位移均集中于钢板中部螺钉孔附近,其最大Von Mises应力达129.95 MPa;骨折线位移空心螺钉组(0.01577 mm)小于锁定钢板组(0.02103 mm);(2)两组内固定的最大应力均低于材料的屈服强度;(3)两组跟骨模型在距下关节附近发生最大位移;(4)结果表明,空心螺钉与锁定钢板内固定用于治疗SandersⅡ型跟骨骨折均具有良好的稳定性,且撬拨复位空心螺钉内固定具有减少术后并发症发生等优点,是SandersⅡ型跟骨骨折较为推荐的内固定方式。BACKGROUND:For Sanders typeⅡcalcaneal fractures,the"L-shaped"incision with locking plate internal fixation often causes complications such as necrosis of the surgical incision flap.The internal fixation with hollow screws after prying and resetting can well avoid this problem,but there is still a lack of evaluation of the effect of internal fixation.OBJECTIVE:To compare and study the fixation effect and mechanical stability of the two fixation methods for SandersⅡtype calcaneal fractures based on the finite element analysis method.METHODS:One male volunteer(25 years old,height 175 cm,weight 75 kg)was screened,and a full-thickness continuous scan was performed from the middle part of the tibia to the whole foot by tomographic CT scan.Based on CT scan data,a complete three-dimensional finite element analysis model of the calcaneus was established.The SandersⅡtype calcaneal fracture was simulated,and locking plate fixation(locking plate group)and hollow screw compression fixation(hollow screw group)were performed after prying reduction.The stress distribution,displacement and fracture displacement performance of the two fixation methods were compared under the same constraints and loads on the two sets of models.RESULTS AND CONCLUSION:(1)The stress of hollow screw internal fixation was concentrated near the fracture line contact,and maximum Von Mises stress reached 53.948 MPa.The displacement of the horizontal hollow screw was larger than that of the longitudinal screw,and the maximum displacement was up to 0.17537 mm.The fixed stress and displacement of the locking steel plate were concentrated near the screw hole in the middle of the steel plate.The maximum Von Mises stress reached 129.95 MPa.The fracture line displacement of the hollow screw group(0.01577 mm)was smaller than that of the locking plate group(0.02103 mm).(2)The maximum stress of the two sets of internal fixation was lower than the yield strength of the material.(3)The two groups of calcaneal models had the largest displacement near the subtala

关 键 词：跟骨骨折 SandersⅡ型骨折 骨折内固定 有限元分析 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R363[医药卫生—临床医学]